Is fidaxomicin worth the cost? The verdict is still out!

TO THE EDITOR—We read with interest the article entitled " Is Fidaxomicin Worth the Cost? An Economic Analysis, " by Bartsch et al [1]. The analytical methods used by the authors seem appropriate for the research question posed. However, several assumptions are not appropriate. The authors assumed that a second course of therapy is cura-tive, with no chance of recurrence. That means that a relatively less effective first-line therapy could actually result in a better outcome than a better first-line treatment, because a second round of therapy for the less effective treatment would have a 100% cure rate. This assumption is inappropriate. Furthermore, we were not able to verify the data used in the parameter settings. There seems to be a discrepancy between the quoted literature from which the data were supposedly taken and the data used in economic modeling. To identify what the cause may have been, we verified if the literature was out of sequence, but this did not seem to be the case. We also verified if the data may have been abstracted from other published literature, but we were not able to identify these alternative sources. Below are the data points in the article we believe are erroneous: 1. The costs of hospitalization for different age groups as used in the analysis are not consistent with the numbers in the quoted reference " HCUP [Healthcare Cost and Utilization Project] facts and figures: statistics on hospital-based care in the United States, 2009 " [2]. We made an attempt to adjust the cost into 2012 US dollars using the discount rate of 3% used in Bartsch et al's article [1], but were not able to get the same results. Some numbers are larger and some are smaller. We considered medical inflation as well. However, taking this approach, which was not mentioned in their article, we were not able to replicate the data.